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[Splenic infarction caused by vascular pedicle torsion]
A I Lo Monte1, C Labruzzo, F K Sardo
1Istituto di Chirurgia Generale e dei Trapianti d'Organo, Università degli Studi di Palermo.
Annali Italiani Di Chirurgia
|February 29, 2000
Summary
A young man with sickle cell trait experienced severe abdominal pain due to spleen infarction from vascular pedicle torsion. Urgent splenectomy resolved the condition, highlighting the need to consider splenic emergencies in acute abdomen cases.
Area of Science:
- Vascular Surgery
- Abdominal Imaging
- Hematology
Background:
- Splenic infarction is a rare condition that can present as an acute abdomen.
- Vascular pedicle torsion leading to splenic infarction is exceptionally uncommon.
Observation:
- A 25-year-old male with heterozygous hemoglobin S (HbS) presented with acute left upper quadrant abdominal pain, fever, and signs of acute abdomen.
- Initial investigations ruled out common occlusive and hematologic causes.
- Ultrasonography revealed splenomegaly with a twisted appearance and decreased signal intensity areas suggestive of splenic infarction, along with free fluid in the pouch of Douglas.
Findings:
- Urgent splenectomy was performed, confirming splenomegaly, a significantly twisted vascular pedicle, and multiple splenic infarcts.
- Ruptured infarcts led to hemoperitoneum, necessitating the emergency surgery.
- The patient's symptoms resolved post-splenectomy.
Implications:
- This case underscores the importance of considering splenic vascular emergencies, particularly torsion, in the differential diagnosis of acute abdomen, especially when trauma is absent.
- Ultrasonography is a valuable non-invasive tool for diagnosing splenic infarction and guiding surgical management.
- Prompt diagnosis and surgical intervention are crucial for favorable outcomes in splenic infarction due to vascular pedicle torsion.